Remote Accommodations Clinical Specialist- Bilingual French, Hindi, Bengali or more

Lensa; Columbus (OH); Remote; USD 63,000 - 65,000; Full time

Job summary

A leading company in risk and claims management is seeking a Remote Accommodations Clinical Specialist. This role involves performing clinical evaluations on claims, consulting with providers, and ensuring that medical information supports employee absences. Candidates must be bilingual and have relevant experience, with a competitive salary and benefits package offered.

Qualifications

• Bachelor's degree preferred.
• Current CRC or RN license required.
• Four years of related experience or equivalent, including one year of return-to-work experience.

Responsibilities

• Evaluate complex claims to determine medically supported work restrictions.
• Perform clinical reviews of medical claims based on client requirements.
• Communicate clinical status and recommendations to employees and providers.

Skills

Communication

Analytical skills

Interpersonal skills

Critical thinking

Organizational skills

Education

Bachelor's degree from an accredited college or university

Current Certified Rehabilitation Counselor (CRC) or Registered Nurse (RN) license

Tools

Microsoft Office

Job description

Remote Accommodations Clinical Specialist- Bilingual French, Hindi, Bengali or more

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Sedgwick, is seeking professionals. Apply via Lensa today!

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces, National Top Companies

Certified as a Great Place to Work

Fortune Best Workplaces in Financial Services & Insurance

Remote Accommodations Clinical Specialist- Bilingual French, Hindi, Bengali or more

We are looking for Remote candidates who are bilingual in any of these languages:

• French
• Dutch
• Hindi
• Bengali
• German
• Mandarin
• Portuguese

Must Be Able To Work Within These Hours:

• Monday - Friday
• 8:00 am to 4:00 pm CST
• 11:00 am to 7:00 pm CST
• 5:00 pm to 1:00 am CST
• 11:00 pm to 7:00 am CST
• 1:00 am to 9:00 am CST

Candidates must live within the United States.

PRIMARY PURPOSE: Performs standard clinical evaluations on claims that require additional review based on medical condition, client requirement, and/or complexity. Consults with providers and employees by providing case direction and ensures medical information substantiates the need for employee absence from work or to negotiate, facilitate, and monitor successful return to work of claimants within appropriate disability duration and accommodation guidelines.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

• Consults on and evaluates complex claims to determine objective, quantifiable, medically supported work restrictions/accommodations.
• Performs standard disability clinical reviews of referred medical claims based on client requirements to ensure accurate and sufficient information is received by employees and providers, documenting decision rationale.
• Completes medical reviews of all claims by assessing medical documentation and applying clinical knowledge to substantiate disability and interpret the impact on job functions.
• Communicates clearly and professionally with employees and providers, discussing clinical status, progress, and work status via phone or writing.
• Provides clear follow-up recommendations for ongoing medical management of claims, ensuring appropriate recommendations are made.
• Consistently achieves high-quality audit scores.
• Acts as a clinical resource to claims examiners, offering guidance on medical management of claims, including comprehension of medical terminology and substantiating claim decisions.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES:

• Acts as a backup for key disability claims on an ad hoc basis.
• Performs other duties as assigned.
• Travels as required.

Qualifications:

Education & Licensing: Bachelor's degree from an accredited college or university preferred. Current Certified Rehabilitation Counselor (CRC) or Registered Nurse (RN) license required. Current license, registration, and/or professional designations as required within the jurisdiction. Clinical expertise must be kept current by acquisition of the necessary CEUs to maintain licenses and designations.

Experience: Four (4) years of related experience or equivalent combination of education and experience required, including one (1) year of return-to-work or job accommodation experience OR four (4) years of claims management experience.

Skills & Knowledge:

• Good working knowledge of return-to-work or job accommodation procedures
• Good technical knowledge of claims management procedures
• Knowledge of current medical practices in health care management in various areas (including orthopedics, general medicine, surgery, mental health, obstetrics, oncology, and rehabilitation)
• Excellent communication skills, both oral and written
• Proficient in Microsoft Office
• Analytical, interpretive, organizational, and multitasking skills
• Interpersonal skills and critical thinking
• Ability to work in a team and meet performance standards

WORK ENVIRONMENT:

Consideration for reasonable accommodations will be given. The role involves mental, physical, and sensory demands as described.

The statements are meant to describe the general nature and level of work performed. Management may modify duties as needed.

Compensation ranges from $63,000 - $65,000 annually, with a comprehensive benefits package. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If your experience doesn't match every qualification, consider applying anyway. Sedgwick values diversity and unique skills.

Sedgwick is a global leader in risk and claims management, with over 33,000 colleagues and 10,000 clients worldwide. For more information, visit sedgwick.com.